Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3rd Year Medicine UoM > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

what is the CLO test?

A

aka the rapid urease test
(CLO = cambylobacter like organism test)
used to diagnose H pylori - based on the ability of H pylori to produce urease which breaks Urea down to ammonia and CO2
a biopsy sample is mixed with urea and pH indicator - colour changes if urease is present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

who should be screened for cirrhosis?

A

patients with
hep C infection
men drinking over 50 units and women drinking over 35 units of alcohol
alcohol related diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how is Wilsons disease diagnosed?

A

reduced serum copper
reduced caeruloplasmin
increased 24 hour urinary copper excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is H pylori infection associated with?

A

peptic ulcer disease (95% duodenal and 75% gastric)gastric cancer B cell lymphoma of MALT tissue atrophic gastritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

where does diverticulosis most commonly occur?

A

sigmoid colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

barrets oesophagous increases the risk of which oesophageal cancer?

A

adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are adverse effects of metoclopramide?

A

extrapyramidal effects tardive dyskinesia hyperprolactinaemia parkinsonism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how is haemochromatosis treated?

A

venesection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

when should a diagnosis of IBS be considered?

A

if the patient has any of the following for over 6 months:bloating
abdo pain
change in bowel habit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how is cirrhosis diagnosed?

A 
transient elastography (fibroscan) 
uses a 50-MHz wave - passed from a small transducer on the end of an ultrasound probe. measures stiffness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how is endoscopically negative GORD treated?

A

1 month full dose PPI
if this works - 1 month low dose PPI
if this doesn’t work - H2RA drugs (ranitidine) or prokinetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the features of a pharyngeal pouch?

A

dysphagia regurgitation aspiration neck bulge with gurgles on palpitation halitosis (bad breath)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is Sister Mary Joseph’s node?

A

a palpable nodule in the umblicus due to metastatic cancer from abdo or pelvic region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what % of Crohns patients will have surgery?

A

80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is clostridium difficile?

A

a gram positive rod
often encountered in hospital
it releases an endotoxin which causes the syndrome: pseudomembranous colitis
it usually causes problems when broad spec antibiotics suppress the gut flora

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is peutz-jeghers syndrome and its characteristics?

A

autosomal dominant disease
characterised by hamartomatous polyps - in GI tract, mainly small bowel
pigmentation on lips, oral mucosa, face, soles and palms
intestinal obstruction e.g. intussusception
GI bleeding

50% die from GI cancer by 60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the MELD score?

A

Model for End stage Liver Disease
used more and more instead of Child Pugh score
calculates risk based on INR, creatinine and bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are features of cyclical vomiting syndrome?

A

weight lossloss of appetite abdominal paindiarrhoea dizziness photophobia headaches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is suspected in a young child who develops dysphagia who had a tracheo-oesophageal fistula repaired as a baby?

A

benign oesophageal stricture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the screening tool for malnutrition?

A

MUST Malnutrition Universal Screening Tool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are uses of metoclopramide?

A

GORDgastroperesis (prokinetic action) in combo with analgesics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what prophylactic treatment is there for variceal haemorrhage?

A

propranolol

endoscopic band ligation - at 2 weekly intervals until all varices are gone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is the max unit alcohol recommendation per week?

A

14 for both men and women - spread evenly over 3 days +

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what imaging criteria is needed to diagnose toxic megacolon?

A

transverse colon >6cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are features of hepatic encephalopathy?

A 
confusion, low GCS
hand flap 
constructive apraxia 
triphasic slow waves on ECG
raised ammonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what are the red flags for gastric cancer?

A 
new onset dyspepsia in person age >55 
unexplained vomiting
unexplained weight loss
worsening dysphagia/odynophagia 
epigastric pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

how is Barretts managed?

A

high dose PPI
endoscopic surveillence every 3-5 years for metaplasia
if dysplasia - endescopic intervention is offered. including mucosal resection and radiofrequency ablation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

which bacteria can cause fat malabsorption?

A

giardia lamblia

it is resistant to chlorine so can be transfered in swimming pools abroad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is coeliac disease?

A

a sensitivity to the protein glutan leads to villous atrophy and malabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what are classic features of globus pharyngis?

A

persistent sensation of having a lump in throat - when there is none
usually worse on swallowing saliva
symptoms are intermittent and relieved by swallowing food/drink

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

how is hepatic encephalopathy treated?

A

1st line = lactulose (promotes ammonia excretion and use by gut bacteria)
rifaximin = secondary prevention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what are features of autoimmune hepatitis?

A 
signs of chronic liver disease
amenorrhoea 
acute liver failure 
ANA/SMA/LKM1 antibodies 
raised IgG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what are the presenting features of haemochromotosis?

A

fatigue, erectile dysfunction arthralgia and arthiritis (mainly of hands) grey/bronze skin pigmentation liver: signs of chronic liver disease
diabetes
hypogonadism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what factors are considered in the modified glasgow score?

A

low oxygen increased age raised urealow calcium raised LDH/ASTlow albumin raised WBC - neutrophilia raised glucosethe acronym PANCREAS helps us to remember PaO2, Age, Neutrophilia, Calcium, Renal function - ura, Enzymes - LDH, AST, Albumin, Sugar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what are causes for increased ferritin without iron overload?

A 
inflammation 
alcohol excess
liver disease
chronic kidney disease
malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is the MoA of metoclopramide?

A

it is a D2 (dopaminergic) antagonist anti-emetic medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what is Budd Chiari syndrome?

A

also known as
hepatic vein thrombosis
usually seen in the context of other haematological disease or procoagulant state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

how do patients present with UC?

A

bloody diarrhoea lower left abdo pain tenesmus urgency extra intestinal features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what does vitamin B6 deficiency cause?

A

peripheral neuropathy

sideroblastic anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what is systemic sclerosis?

A

an autoimmune disease affecting connective tissue.
can be localised or systemic
characterised by skin thickening due to collagen and small artery damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

how should endoscopic proven GORD be treated?

A

1-2 months full dose PPI
if this works - then low dose for 1 month
if this has no effect- double dose for 1 month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

how is diarrhoea defined?

A

> 3 watery stools / day >14 days = chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what is mallory-weiss syndrome?

A

severe vomiting leads to painful mucosal lacerations at the gastro-oesophageal junction - causing haematemesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

how are UC flare ups classified?

A

mild <4 stools /day
moderate 4-6 stools/day
severe >6 stools/day signs of systemic disturbance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

which medications are important to avoid in bowel obstruction?

A

pro-kinetics e.g. metaclopramide

may cause a perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what are complications of GORDs disease?

A 
benign strictures 
Barretts
anaemia 
ulcers 
oesophagitis 
carcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

how does Vitamin C deficiency present?

A

gingivitis, loose teeth
general malaise
gum bleeding, haematuria, epistaxis
poor wound healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what are the diagnostic tests for haemochromatosis?

A

molecular genetic testing for C282Y and H63D

liver biopsy - Perls stain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

what are features of Crohns disease?

A 
non specific- lethargy and weight loss
abdo pain 
diarrhoea (can be bloody)
peri-anal disease - skin tags/ulcers 
extra intestinal features
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

a patient is found to have iron deficiency anaemia 10 days before surgery, what treatment should she be given?

A 
IV iron (ferric carboxymaltose) 1g and repeated 1 week later 
(if not enough time or oral iron is not tolerated)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

when is an UC flare up considered severe?

A 
blood in stools or passing >6 stools/ day 
and 1 of the following:
- HR >90 
- anaemia 
- temp >37.8
- ESR > 30
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what is the modified glasgow score for?

A

for scoring the severity of acute pancreatitis if 3+ factors are identified within 48 hours - it is severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

which surgical incision is used in an appendectomy?

A

Lanz (more cosmetic)

or Gridiron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what is the typical iron study profile in haemochromatosis patients?

A

transferrin saturation >50%
Raised ferritin and iron
low TIBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what are the 3 types of colon cancer?

A

sporadic 95 %
HNPCC 5 %
FAP <1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

a parkinson patient develops GORD. which medication must he avoid?

A

metoclopramide

its a dopamine antagonist and may make parkinsonism worse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what will be the HepB serology for previous infection?

A

HbSAb +
Hb C Ab + (if naturally caught) or - (if vaccination)
HbsAg -

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what is the most common type of inherited colon cancer?

A

HNPCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

what is haemobilia?

A

bleeding into the biliary tree

following connecting between splanchnic circulation and intra or extrahepatic biliary system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

what are common causes of hepatomegaly?

A

cirrhosis
right heart failure
malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

how is a pyogenic liver abscess treated?

A

IV antibiotics and image-guided percutaneous drainage

amoxicillin, ciprofloxacin, metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

what are adverse effects of PPIs?

A

can mask features of gastric cancer

can increase risk of fractures and osteoporosis by decreasing the absorption of magnesium and calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

what is gallstone ileus?

A

small bowel obstruction secondary to gallstone impaction

vomiting, abdo pain and distention are seen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

what is the most diagnostic test for suspected mesenteric ischaemia?

A

MR angiogram of the mesenteric vasculature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

what are causes of liver cirrhosis?

A

viral hepatitis B + C
NAFLD
alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

what is the first line test for coeliac disease?

A

tissue transglutaminase antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

how are patients with upper GI bleed resuscitated?

A
  1. insert 2x large bore IV lines immediately
  2. platelet transfusion if platelets<50
  3. FFP if PTT >1.5x the normal
  4. crystalloid fluids to maintain systolic BP / packed RBCs if needed
  5. PPI if non variceal bleeding
    once stable - all patients should have endoscopy (within 24 hours)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what is see on an abdo XR in gallstone ileus?

A

small bowel obstruction

and air in the biliary tree

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

which antibodies may be found in a patient with coelaic disease?

A

tissue transglutaminase Ab (IgA)
anti-endomyseal Abs (igA)
Anti-casein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

how is faecal impaction treated?

A

high-dose macrogol laxatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

what is haemochromatosis?

A

autosomal recessive disease affecting iron absorption and metabolism (due to a mutation in the HFE gene)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

what is the most appropriate test to check H pylori eradication?

A

Urea breath test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

which diagnostic marker is tested to diagnose carcinoid syndrome?

A

5HIAA - from a 24 hour urinary collection

5 hydroxyindoleacetic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

what test is recommended in women > 50 years with IBS symptoms?

A

serum CA 125
suspect ovarian cancer
IBS rarely presents in women this old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

in suspected Gallstones, what is the best investigation?

A

abdominal ultrasound - this will enable us to see if there are gallstones or noturinary bilirubin, or ALT will just tell us generally if there is a cholestatic picture or not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

how is a variceal haemorrhage treated?

A 
stabilise/resucitate patient 
correct bleeding if needed - vit K, FFP
vasoactive drugs - terlipressin 
prophylactic antibiotics - quinolones 
endoscopy - bind ligation  
Sengstaken -blakemore tube if uncontrolled haemorrhage

if all else fails, TIPS procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

how does alcoholic ketoacidosis present?

A

metabolic acidosis
elevated serum ketones
normal or low glucose
elevated anion gap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

what are symptoms of chronic mesenteric ischaemia?

A

episodes of severe, centreal, abdo painworse after eating (when bowel is working hard)arteriopath history - history of previous MI, hypercholesterolaemia, HTN etc.diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

which patients should be offered coeliac serological testing?

A

persistent unexplained abdo/gastro symptoms diagnosis of autoimmune thyroid disease or diabetes 1 faltering growth unexpected weight loss prolonged fatiguesevere/persistent mouth ulcers unexplained B12, folate or iron deficiencyIBS1st degree relative with coeliac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

what are causes of chronic diarrhoea?

A 
IBS 
ulcerative colitis 
Crohns disease 
coeliac disease 
 colorectal cancer 
bile acid malabsorption 
pancreas disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

what is hepatorenal syndrome? (HRS)

A

rapid deterioration of kidneys in patients with cirrhosis or fulminant liver.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

what are causes of acute liver failure?

A

alcohol
paracetamol
viral hepatitis A or B
acute fatty liver of pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

what is CREST syndrome?

A 
a limited sclerodoma 
Calcinosis (thickening of skin)
Raynauds 
Eosphageal dysmobility 
Sclerodactyly (tighetning and hardening of toes/finger skin)
Telangiectasia (spider veins on face)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

how does a patient with faecal impaction present?

A

overflow diarrhoea may occurthis is suspected with a history of very liquidy diarrhoea and occasional incompetance along with the odd hard stool and abdo pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Boerhaave syndrome

A

severe vomiting leading to oesophageal rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

why do coeliac patients receive a pneumococcal vaccination?

A

they have functional hyposplenism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

how is malnutrition defined?

A

BMI <18.5unintentional weight loss of 10% + in 3-6 months or BMI <20 with unintentional weight loss of 5%+ in 3-6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

what are features of PSC?

A

cholestasis - pruritis and jaundice
fatigue
RUQ pain
ANCA (anti neutrophil cytoplasmic antibodies) positive and anti SM Abs
on ERCP - multiple strictures give beaded appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

when is a positive diagnosis of IBS made?

A

if the patient has

1) abdo pain relieved by defecation or
2) abdo pain associated with change in bowel frequency/stool form and 2 of the following
1) altered stool passage (straining, urgency, incomplete evacuation)
2) bloating
3) made worse by eating
4) passage of mucus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

how is dyspepsia treated?

A

1 month trial of full dose PPI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

what is seen in UC on barium enema?

A

loss of haustrations
superficial ulcerations - pseudopolyps
long standing disease will causes long, narrow colon (drainpipe/lead-pipe)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

what is pellagra?

A

vitamin B3 deficiency - niacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

what is carcinoid syndrome?

A

when metastases are present in the liver and release serotonin (so the serotonin avoids first pass metabolism in the liver)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

how do you differentiate between alcoholic and diabetic ketoacidosis?

A

hypoglycaemia is associated with alcoholic

hyperglycaemic with diabetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

how is remission induced in a UC flare up?

A
  1. rectal aminosalicylates (5-ASA) or steroids. rectal mesalazine is superior
  2. oral aminosalicylates
  3. second line = oral prednisolone (wait 4 weeks before deciding aminosalicylate treatment hasn’t worked)
  4. IV steroids in severe collitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

what are the features of NAFLD?

A

usually asymptomatic
hepatomegaly
more ALT than AST
increased echogenecity on ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

what is a possible complication of coeliac disease which may cause night sweats, fever, lymphadenopathy?

A

Enteropathy-associated T cell lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

which surgical incision is used in a cholcystectomy?

A

Kocher’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

how do we investigate for NAFLD?

A

there is no indication for screening
it is usually an incidental finding - fatty changes on ultrasound
if fatty changes are picked up on US, NICE recommend ELF (enhance liver fibrosis) blood test to pick up any advanced fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

what are risk factors for C dif infection?

A 
broad/multiple antibiotics 
immunosuppression 
PPI
long hospital stays 
GI tract surgery 
Inflam bowel disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

what are complications of Crohns disease?

A

fistulae, strictures, adhesions (inflammation through all layers of bowel wall)colorectal cancer small bowel canceroesteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

how is haemobilia upper GI treated?

A

if it is a minor bleed - ensure patient is haemodynamically sstable and then no further treatment

if severe bleed - surgery needed . often a transcatheter hepatic artery embolisation to help prevent bleeding
if this doesnt work then surgical exploraiton and repair of the biliary tree may be indicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

what are the causes of pancreatitis?

A

GET SMASHEDGallstones Ethanol Trauma Steroids Mumps AutoimmuneScorpion venom Hypertriglycerides, hyprecalcaemia, hypothermia ERCPDrugs = mesalazine, bendroflumethiazide, furosamide, steroids, sodium valproate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

which antibodies are present in the 3 different types of autoimmune hepatitis?

A

type 1 : Anti SM and Anti nuclear antibodies. seen in adults and children
type 2: liver/kidney microsomal type 1 antibodies (LKM1) - seen in children
type 3 - soluble liver-kidney antigen. seen in middle ages adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

what is the classic presentation for diverticulitis?

A

left iliac fossa pain and tenderness
anorexia, vomiting and nausea
diarrhoea
features of infection - pyrexia, raised WBC, raised CRP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

what are features of budd chiari syndrome?

A

ascites
sudden onset, severe abdo pain
tender hepatomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

which inflammatory bowel disease is crypt abscesses most associated with?

A

ulcerative collitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

which 2 arteries does the TIPS (transjugular intrahepatic portosystemic shunt) procedure connect?

A

portal vein and hepatic vein
this aims to treat portal hypertension and does this by creating a shunt between the portal vein and hepatic vein, allowing the blood to bypass the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

what are the 2 most common causes of lower abdo pain in young males?

A

appendicitis or testicular problems (torsion or infection)crucial to inspect scrotum to ensure not missing out the cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

what is the pathophysiology of HRS?

A

portal hypertension
leads to splanchnic vasodilation which then causes systemic vascular resistance
which means decreased effective circulatory volume
RAAS activated
causing renal vasoconstriction - and then HRS
and renal sodium avidity- and then ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

what is acute acalculous cholecystitis? ACC

A

an inflammatory condition of the gall bladder - without involving gallstones or cystic duct obstruction = normal imaging
usually associated with a co-morbidity e.g. diabetes, shock, cardiac arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

what is Wilson’s disease?

A

an autosomal recessive disease characterised by excessive copper deposit in tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

which oesophageal cancer is associated with barretts?

A

adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

what is the connection between sushi consumption and cancer?

A

fish are high in nitrosamines which are carcinogens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

what dietary advice should be given to IBS patients?

A

have regular meals, don’t miss meals
drink 8 cups a day
restrict intake of tea, coffee, alcohol, fizzy drinks
reduce high-fibre content
limit fresh fruit
reduce resistant starch
wind and bloating - increase intake of oats and linseed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

what is the best primary care investigation to differentiate between IBS and IBD?

A

faecal calprotectin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

what does a Crohns biopsy look like?

A

inflammation from mucosa to serosa
granulomatas
goblet cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

what is the best way to screen for harmful alcohol use and dependence?

A

AUDIT questionnaire

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

what is melanosis coli?

A

pigmentation of the bowel wallbiopsy shows pigment-laden macrophages it is associated with laxative abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

what is primary sclerosing cholangitis?

A

disease with unknown aetiology

characteristics = fibrosis and inflammation of intra and extra hepatic bile ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

what will a jeujunal biopsy in a coeliac patient show?

A

villous atrophy
crypt hyperplasia
increase in intraepithelial lymphocytes
lamina propria infiltration with lymphocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

what do you suspect when an obese T2DM patient with deranged LFTs presents?

A

non alcoholic fatty liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

what is the Blatchford score?

A 
a score used to assess and risk stratify patients with an Upper GI bleed 
it includes the following factors:
Urea 
Hb
Systolic BP
pulse 
syncope 
melaena 
cardiac failure 
hepatic disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

what are investigation findings in Crohn’s disease?

A

raised inflammatory markers raised faecal calprotectin anaemia low Vit D and B12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

how do you calculate No. of alcoholic units in a drink?

A

drink volume mL x % alcohol (ABV) /1000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

what is the Waterlow score?

A

predicts risk of pressure sore

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

what are complications of primary biliary cholangitis?

A

malabsorption: osteomalacia, coagulopathy
sicca syndrome - occurs in 70% (dry mouth)
portal hypertension - variceal haemorrhage, ascites
hepatocellular carcinoma (20-fold increase)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

what is the gold standard investigation for suspected oesophageal cancer?

A

endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

how is H pylori treated?

A

PPI + amoxacillin + clarithromycin or

PPI + metronidazole + clarithromycin

130
Q

what are features of oesophageal cancer?

A

weight loss dysphagia vomiting anorexia odynophagia, hoarsness, melaena, cough

131
Q

what is intussusception?

A

when some intestine folds inside of itself- causing a blockage

132
Q

what triad suggests liver failure?

A

encephalopathy (hand flap and confusion)
coagulopathy (raised prothrombin time)
Jaundice (raised bilirubin)
as well as hypoalbuminae

133
Q

what are features of Whipples disease?

A 
malabsorption - diarrhoea , weight loss 
large joint arthralgia 
skin - pigmentation and hyper-photosensitivity 
lymphadenopathy 
pleurisy and pericarditis
rare - neurological symptoms
134
Q

what is Whipple’s disease?

A

a rare multi-systemic disorder caused by tropheryma whippellii infection
jejunal biopsy shows deposition of macrophages containing PAS granules (periodic acid -schiff)

135
Q

how is C dif diagnosed?

A

by detecting C Dif toxin in the stools (CDT)

136
Q

what is a pharyngeal pouch?

A

it is a posteriomedial diverticulum through Killians Dehisence Killians Dehisence is a triangle in the wall of the pharynx between the cricopharyngeous and thyropharyngeous muscles

137
Q

what are features of Wilson’s disease?

A

liver disease, neurological symptoms, corneal rings (ksyser fliesher rings), haemolysis, blue nails

138
Q

what are side effects of mesalazine?

A

pancreatitis, GI upset, headaches, agranulocytosis, interstitial nephritis

139
Q

when should a patient with ascites be given prophylaxis against SBP?

A

if the patients has had a previous episode of SBP
or
if the ascites has a protein <15 and a child pugh score <9 or hepatorenal syndrome

140
Q

what triad points to mesenteric ischaemia?

A

history of CVDraised lactateacute abdo pain - tender but soft

141
Q

what is the serum ascites albumin gradient used for?

A

it tells us if the ascites is due to portal hypertension or not
if the SAAG is > 11g/L = due to portal hypertension

142
Q

Non alcoholic fatty liver disease covers a range of diseases, including…

A

steatosis
steatohepatitis (non alcoholic steatohepatitis - NASH)
progressive disease may go on to fibrosis and cirrhosis

143
Q

what are complications of diverticulitis?

A

perforation
abscess formation
peritinitis
obstruction

144
Q

what needs to be excluded in painless jaundice?

A

pancreatic cancer

145
Q

how is the AUDIT questionnaire used?

A

its a 10 item questionnaire
max points = 40
a score >15 in men and >13 in women is likely to indicate alcohol dependence
AUDIT - C = abbreviated if little time

146
Q

what should be administered to patients before an appendectomy ?

A

IV antibiotics

co-amoxiclav

147
Q

what are the features of pellagra?

A

dermititis - classic sunburn rash dementia/dellusion diarrhoea

148
Q

what is the ABG pattern seen in mesenteric ischaemia?

A

metabolic acidosis (raised lactate, low bicarbonate)

149
Q

how is primary biliary cholangitis diagnosed?

A

anti mitochondrial antibodies M2 = seen in 98% patients anti SM antibodies seen in 30%raised IgM

150
Q

how is a c dif infection treated?

A

1st line= oral metronidazole (10- 14 days)
2nd line =oral vancomycin
3rd line = oral vancomycin and IV metronidazole

151
Q

what is an important side effect of Isoniazid? ( a Tb medication)

A

Vitamin B6 deficiency - causing peripheral neuropathy

usually prophylactic pyridoxine hydrochloride i prescribed alongside isoniazid

152
Q

how do we maintain remission in Crohn’s patients?

A

azathioprine or mercaptopurine are first line
second line = methotrexate
mesalazine can be considered in patients with previous surgery

153
Q

which antibiotic is now the leading cause of C dif?

A

3rd gen cephalosporins e.g. ceftriaxone

154
Q

how is zollinger ellison syndrome diagnosed?

A

fasting gastrin levels

155
Q

how does cyclical vomiting syndrome present?

A

severe nausea and sudden vomiting lasting for hours to days.prodromal intense sweating and nausea associated with migraine history

156
Q

what are the 2 most common causes of upper GI bleed?

A

peptic ulcer disease or oesophageal varices

157
Q

what are the features of zollinger ellison syndrome?

A 
raised levels of gastrin 
usually due to a gastrin secreting tumour (in pancreas or duodenum) 
multiple peptic ulcers
malabsorption 
diarrhoea 
30% occur as part of MEN 1 syndrome
158
Q

how does the urea breath test work?

A

the patient consumes a drink containing carbon 13 isotope
after 30 minutes, the patient exhales into a glass tube
mass spectrometry analyses the amount the C13 CO2
(suggesting presence of H pylori - urease)
shouldnt be performed within 4 weeks of antibacterials or 2 weeks of PPIs

159
Q

what does the ELF (enhanced liver fibrosis) blood test actually test for?

A

hyaluronic acid
procollagen 3
tissue inhibitor of metalloproteinase 1

160
Q

what is the MoA of loperamide?

A

loperamide slows down gut motility - its an anti-diarrhoeal it is a meu- opioid receptor agonist - in the submucosal neural plexus of the intestinal wall. this decreases peristalsis and therefore gastric motility

161
Q

what is the most common cause of hepatocellular carcinoma?

A

world wide = chronic hepatitis B
in europe = chronic hepatitis C
the main risk factor is cirrhosis which is caused by the chronic hepatitis

162
Q

what is Rovsing’s sign?

A

seen in apendicitis when palpating the LIF the patient feels pain in the RIF

163
Q

how does oesophagitis present?

A

history of heart burn
painful swallowing - especially with bulky foods, retrosternal discomfort
systemically well
no weight loss

164
Q

what is spontaneous bacterial peritonitis? SBP

A

a form of peritonitis usually seen in patients with ascites secondary to cirrhosis

165
Q

clindamycin is associated with which bacterial infection?

A

c dif

166
Q

what is the most prominent Crohns symptom in adults?

A

diarrhoea

167
Q

which surgical incision is used in a caesarian section ?

A

Pfannenstials

transverse super pubic

168
Q

what is plummer-vinson syndrome?

A

triad of dysphagia (secondary to oesophageal webs) glossitis, iron deficiency

169
Q

what is associated with primary sclerosing cholangitis?

A

ulcerative colitis (80% of PSC patients have UC)
Crohns -less so
HIV

170
Q

what are the features of primary biliary cholangitis?

A

middle aged womenpruritus lethargy LFTS: raise in ALP and gamma GT

171
Q

how is Whipple’s disease treated?

A

year of antibiotics

co-trimoxazole best

172
Q

how is cyclical vomiting syndrome managed?

A

avoidance of triggersprophylaxis: amitriptyline, propranolol and topiramate acute episodes: triptans, ondansetaron, prochlorperazinr

173
Q

how may myasthenia gravis present?

A

dysphagia for both solids and liquids
weakness of extraoccular muscles (double vision)
ptosis

174
Q

what is metabolic syndrome?

A

a combination of diabetes, hypertension, raised triglycerides, low HDL, abdominal obesity

175
Q

what does the Hb C Antigen indicate?

A

infectivity

176
Q

how does congestive hepatomegaly present?

A

persistent dull RUQ ache

with a history of heart failure

177
Q

which antibodies are found in systemic lupus?

A

anti-dsDNA antibodies

although these can be present in normal individuals

178
Q

with which IBD is primary sclerosing cholangitis most associated?

A

ulcerative colitis

179
Q

what are extra-intestinal features of UC and CD?

A

arthirits episcleritiserythema nodosum osteoporosis

180
Q

what is the most common type of OES cancer?

A

adenocarcinoma associated with GORDs/Barrets

181
Q

how is IBS managed?

A

first line medication:
- diarrhoea = loperamide (anti-motility agent)
- constipation = laxatives e.g. sorbital/magnesium/bisacodyl/sennosides
(not lactulose) (second line laxative = linaclotide)
- pain = antispasmodics (dicyclomine, hyoscamine, buscopan)

second line = low dose TCAs e.g. 5-10mg amitriptyline
3rd line = eluxadoline

psychological and dietary advice

182
Q

why can hoarsness be a sign of oesophageal cancer?

A

the cancer can interfere with the recurrent laryngeal nerve

183
Q

according to ICD-10, when is a diagnosis of alcohol dependence made?

A

it the patient has 3 + of the following:
compulsion to drink
difficulty controlling alcohol consumption
physiological withdrawal
tolerant to alcohol
persistent use of alcohol despite harm
neglect of alternative activities outside of drinking

184
Q

what is primary biliary cholangitis ?

A

a chronic liver disorder seen in middle aged women. intralobular biliary ducts become damaged by chronic inflammatory process which leads to cholestasis and eventually cirrhosis.

185
Q

which vitamin, if taken in high doses, can be teratogenic?

A

vitamin A

186
Q

what are features of carcinoid syndrome?

A 
flushing (earliest symptom)
diarrhoea 
palpitations
hypotension 
bronchospasm
right sided valvular stenosis if ACTH and GHRH are also secreted may present with other syndromes e.g. Cushings
187
Q

which diabetic medication can cause cholestasis?

A

sulphonylureas e.g. gliclazide

188
Q

in UC, which part of the bowel is most effected?

A

Rectum

189
Q

what factors is the GCS based on ?

A 
eye opening response 
verbal response
motor response 
out of 15 
<9 = major brain injury 
9-12 = moderate
190
Q

what is the most important diagnostic test for achalasia?

A

manometry showing excessive LOS tone which doesn’t relax on swallowingother tests include barium swallow and CXR

191
Q

what is achalasia?

A

failure of oesophageal persitalsis and failure of relaxation of LOS due to degenerative losses of ganglia in the Auerbach’s plexus.

192
Q

what are markers for excess alcohol consumption?

A

macrocytosis

raised gamma glutamyl transferase

193
Q

how is Wilson’s disease treated?

A

penicillamine = first line. it chelates iron

trientine hydrochloride = alternative chelating agent

194
Q

what cells point towards a gastric adenocarcinoma?

A

signet ring cells

195
Q

when testing for tTG what condition must be met?

A

patient must have eaten gluten for 6 weeks before the test

196
Q

which cancers are patients with HNPCC at risk of?

A

colon cancer - main

endometrial cancer - second

197
Q

which upper GI symptoms require a 2 week urgent referal?

A

all patients with
dysphagia
upper abdo mass
weight loss AND pain, reflux or dyspepsia and >55years old

198
Q

how is a patient with cirrhosis managed?

A

6 month ultrasound to check for hepatocellular carcinoma

endoscopy to check for oesophageal varices

199
Q

how long should a c dif patient be isolated for?

A

48 hours

200
Q

achalasia increases the risk of which oesophageal cancer?

A

squamous cell carcinoma

201
Q

how does haemobilia present?

A

jaundice
upper GI bleeding
RUQ pain
(Quincke’s triad)

202
Q

what is the most prominent Crohns symptom in children?

A

abdominal pain

203
Q

how does viral hepatitis present?

A

history of travel abroad

RUQ pain, lethargy, nausea, anorexia

204
Q

how is HRS managed?

A

vasopressin analogues e.g. terlipressin - causes splanchnic vasoconstriction

volume bulking with 20% albumin

or TIPS procedure

205
Q

is an abdominal mass in RIF more likely to occur in Crohns or UC?

A

Crohns

206
Q

what is Kantors string sign?

A

seen in Crohns disease
on a barium study
it is a long segment of narrowed terminal ileum - string like

207
Q

what should primary care investigation for suspected IBS include?

A

ESR/CRPttG antibodies FBC

208
Q

what are causes of acute diarrhoea?

A

gastroenteritis diverticulitis antibiotic therapy constipation causing overflow diarrhoea

209
Q

which antibiotic should be given as a prophylactic treatment for SBP?

A

ciprofloxacin or norfloxacin

210
Q

What is Child Pugh classification? what factors does it look at?

A 
assesses the severity of liver cirrhosis 
it takes into account:
bilirubin 
albumin
prothrombin time 
encephalopathy 
ascites
211
Q

what alcohol screening tools are there?

A

AUDIT
FAST
CAGE

212
Q

what is the most common extra-intestinal feature of UC and CD?

A

arthritis

213
Q

how do we induce remission in Crohns patients?

A

stop smoking
iv/oral steroids
enteral feeding with elemental diet
mesalazine - 2nd line to steroids
azathioprine or mercaptopurine may be used as an add on to induce remission. (not to be used as monotherapy)
methotrexate can be used in place of azathioprine
infliximab is useful in refractory disease or fistulating Crohns
metronidazole can be used for peri-anal disease

214
Q

what is ferritin?

A

an intracellular protein that binds iron and releases it where it is needed
it is an acute phase reactent - so raises in inflammation

215
Q

how is remission maintained in UC?

A 
oral aminosalicylates (mesalazine)
azathioprine and mercaptopurine
216
Q

what are features of achalasia?

A

difficulty swallowing both solids and liquids Barium swallow shows: dilated oesophagus tapering off at the LOSheartburn regurgitation of food

217
Q

how do we use the blatchford score?

A

score 0 = low risk, early discharge/outpatient treatment

score 6+ = 50% chance that the patient will need an intervention

218
Q

what is a salpingectomy?

A

surgical removal of a fallopian tube

219
Q

what are the features of Gilbert’s syndrome?

A

isolated hyperbilirubinaemia

an autosomal recessive disease of bilirubin conjugation due to a deficiency of UDP glucuronyl transferase

220
Q

what histological changes occur in Barrett’s oesophagus?

A

metaplastic conversion of squamous epithelium of the oesophageous to columnar cells (similar to stomach)

221
Q

what is the strongest risk factors for Barretts?

A

chronic GORD

222
Q

how is Barretts Oesophagus managed?

A

depending on the staging
metaplasia = endoscopic surveillance
(< 3 cm - every 3-5 years)
(> 3 cm - every 2-3 years)
low grade dysplasia = 6 monthly surveillance/ endoscopic therapy (radiofreuency ablation/mucosal resection)
high grade dysplasia = endoscopic therapy
adenocarcinoma = surgery: oesophagectomy

223
Q

what medication is presecribed for Barretts oesophagus?

A

20mg PPI daily

224
Q

what are the main risk factors for oesophageal adenocarcimona?

A

GORD and Barretts.
seen in distal 1/3 of OES
developed world disease
most common oes. cancer in UK

225
Q

what are the main risk factors of squamous cell carcimona (oesophageal)?

A

alcohol and smoking
proximal 2/3 OES
developing world disease

226
Q

what are the tissue layers of the oesophagus?

A 
epithelial cells
basement membrane 
lamina propria 
muscularis mucosae
submucosa
muscularis propria 
adventitia
227
Q

how is oesophageal cancer managed?

A

Carcinoma in situ/early T1 - endoscopic resection
T1, T2 NO = surgery
M1, T4 = palliative care
T3, N1 = chemoradiation, then re-evaluate for surgery

228
Q

what do parietal cells produce??

A 
intrinsic factor (absorbs B12)
HCl
229
Q

what do chief cells produce?

A

pepsinogen

chymosin/renin in neonates

230
Q

what are symptoms of oesophageal candidis?

A

dysphagia
pain in tongue
odynophagia

231
Q

how is oesopahgeal candidis treated?

A

fluconazole (-azole) = anti fungal

232
Q

how does a duodenal ulcer present?

A

severe, pain radiating to back
relieved by eating
tarry stools

233
Q

what are main causes for peptic ulcers?

A

H pylori - responsible for 90% duodenal ulcers

NSAIDs

234
Q

what is the mechanism via which NSAIDs cause peptic ulcers?

A
  1. COX-1 inhibition; decreased prostaglandins; reduced mucosal protection and blood flow
  2. topical irritation
  3. COX -2 inhibitions; neutrophil adherence; mucosal injury
235
Q

which risk factor is associated with gastric ulcers?

A

NSAIDs

236
Q

which risk factor is associated with duodenal ulcers?

A

H pylori

237
Q

give examples of histamine receptor blockers?

A

ranitidine
famotidine
cimetidine

238
Q

how are peptic ulcers treated?

A

H pylori eradication therapy for those who test positive
stop NSAID use
8 weeks full dose PPI or H2RA

239
Q

what are complications of peptic ulcers?

A

internal bleeding
perforation
gastric outlet obstruction
malignant transformation

240
Q

what is the most common oesophageal disease in the UK?

A

GORD

241
Q

what are symptoms of an acute upper GI bleed?

A

haematemesis
malena
hypovolaemia/syncope
abdominal pain

242
Q

what are the common causes for an acute upper GI bleed?

A
  1. peptic ulcer disease
  2. erosions
  3. oesophagitis
  4. varices
243
Q

what is the Rockall score used for?

A

used after endoscopy in acute GI bleed patients

scores prognosis/mortality

244
Q

what are differentials for fresh blood in stools??

A 
haemorrhoids 
irritable bowel disease 
acute anal fissure 
colo-rectal neoplasms
acute proctitis
245
Q

how are anal fissures treated?

A
  1. conservative; high fibre intake, high fluid intake, topical analgesia
  2. topical glyceral trinitrate, relaxes anus. may cause headaches
  3. diltiazem (CCB) = relazes anus
246
Q

how are resistant anal fissures treated?

A 
botox injections
surgical sphincterotomy (risk of faecal incontinence)
247
Q

how does colorectal cancer present?

A 
abdo pain 
rectal bleeding
weight loss 
change in bowel habit
microcytic anaemia
248
Q

what are the criteria for a suspected colorectal cancer referal?

A

unexplained iron deficiency anaemia
>6 weeks change in bowel habit and bleeding
right sided palpable mass/rectal mass
>60 years old and >6 weeks change in bowel habit
>60 years old and rectal bleeding (w/o anal symptoms)

249
Q

what investigations are performed for suspected colorectal cancer?

A

colonoscopy/sigmoidoscopy
blood test for CEA (Carcinoembryonic antigen) - tumour marker for colorectal cancer
biopsy to confirm and stage tumour

250
Q

who qualifies for colorectal screening?

A

patients aged 60-69
screen performed 2 yearly
based on faecal occult blood test

251
Q

what is the sequence of carciogenic change of bowel epithelia?

A

normal epithelium - early adenoma - intermediate adenoma - late adenoma - carcinoma - metastasis

252
Q

what mutation is present in FAP?

A

mutation in apc allele

253
Q

what mutation causes Hereditary Non polyposis CRC?

A

mutation in the mix match gene - causing microsatellite instability

254
Q

what is another name for HNPCC?

A

lynch syndrome

255
Q

what is the amsterdam criteria ?

A

used in diagnosis of HNPCC

321
3 family member 
2 generations
1 under 50 
have coloractal cancer
256
Q

which part of the colon does colorectal cancer occur most?

A

sigmoid

257
Q

what is Duke’s classification?

A

staging of colorectal cancer
A- cancer in innermost lining and maybe muscle
B- cancer grown through the muscle lining
C - lymph node involvement
D - metastasis

258
Q

what are the characteristic of an ileostomy?

A

spouted, usually in RIF, continueous liquid floq

259
Q

what are the characteristics of a colostomy?

A

not spouted, LIF, solid periodic outflow

260
Q

what is Hartmanns procedure?

A

a pathological segment is removed from the descending colon/ rectosigmoid colon and no anastomosis is made. instead the stump is brought through the abdominal wall and a colostomy formed

261
Q

how does diverticulosis present?

A

recurrent LLQ pain, fever, bloating, constipation/diarrhoea

262
Q

what investigation should be performed in suspected acute diverticulitis?

A

CT scan - to confirm suspicion and rule out complications

263
Q

how is uncomplicated diverticulitis treated?

A

low residue diet
oral antibiotics (7-10 days) amoxacillin/clavulanic acid or
metronidazole + ciprofloxacin

264
Q

which syndromes usually need a laparotomy ?

A

peritonitis

organ rupture

265
Q

what are the Truelove and Witts criteria for assessing UC severity?

A 
divided into mild, moderate and severe
looks at the following factors:
no. stools /day 
temp.
CRP/ESR
resting pulse 
Hb
rectal bleeding
266
Q

what are complications of UC?

A

toxic megacolon, with risk of perforation
VTE (all patients should be given prophylaxis)
hypokalaemia
increased risk of colonic cancer

267
Q

how is remission induced in moderate UC?

A 
rectal mesalazine (superior)
or rectal steroids or oral mesalazine for more extensive disease
2nd line = oral prednisolone
268
Q

how is remission induced in severe UC?

A

patient admitted
IV steroids, rectal steroids, VTE prophylaxis, re-hydration and electrolyte balance
rescue therapy with infliximab or ciclosporin - can avoid colectomy

269
Q

when is a colectomy considered in UC?

A

if presenting with severe UC and patient hasn’t improved by day 7-10
urgent surgery

270
Q

when is biologic therapy indicated in UC?

A 
if immunomodulation (azathioprine) not tolerated or not working 
infliximab
271
Q

how do we define IBD?

A

inappropriate immune response against gut flora in genetically susceptible individuals

272
Q

what is Carnett’s sign ?

A

to determine whether abdominal pain is musculoskeletal or from internal viscera
patient should lie down and raise legs//head - if this exacerbates pain then =MS cause

273
Q

what are bacterial causes of diarrhoea?

A

cambylobacter
C diff
shigella
salmonella

274
Q

what are the different mechanisms of acute diarrhoea??

A

osmotic
secretary
mucosal inflammation
motility disturbance

275
Q

what are important history questions for a patient presenting with infectious diarrhoea?

A

travel? employment? food consumption? animals? recent medication? swimming/drinking safe water supplies? contact with ill person? oral/anal sexual contact? HIV> immunosuppression? gastrectomy?

276
Q

how is infectious diarrhoea managed?

A

rehydration
faecal testing
antibiotics if severe/systemic symptoms

277
Q

what is the most common bacterial gastroenteritis?

A

campylobacter

278
Q

what are features of a campylobacter infection??

A

food borne, faecal oral
reservoir = poultry, cattle, domestic animals
incubation period = 1-7 days
can cause GI ulceration
presents = diarrhoea, malaise, abdo pain. can become serious in 20% patients - pancreatitis, toxic megacolon, peritonitis, cholecystitis

279
Q

how is campylobacter managed?

A

supportive

if severe - macrolide antibiotics e.g. erythromycin, clarithromycin

280
Q

what are features of E coli infection?

A

there are subtypes:
enterotoxigenic - cholera like toxins, seen in travellers/children. food borne. incubation 12-72 hours
enterohaemorrhagic - profuse bloody diarrhoea, seen in all ages. cattle reservoir. shigella like toxins. incubation 12-60 hours

281
Q

what are features of a salmonella infection?

A

common in raw eggs, reptiles
incubation: 12-72 hours
diarrhoea, vomiting and fever
food poisoning

282
Q

what are features of shigella infection?

A

bacillary dysentery
1-8 days incubation
faecal/oral route - contaminated water/food
abdo cramps, bloody diarrhoea, etc

283
Q

how can iatrogenesis lead to problems in IBS?

A
  1. invasive investigations - endoscopies, radiation
  2. unnecessary surgeries
  3. opiates
284
Q

how is acute Hep B treated?

A

treatment usually unnecessary
avoid alcohol
immunise sexual contacts
patients with chronic infection, cirrhosis or HBV DNA >2000 for antivirals

285
Q

when are anti viral medications indicated for Hep B infection?

A

chronic infection
cirrhosis
HBV DNA>2000

286
Q

how is chronic HBV infection treated?

A

antivirals:

  • .peginterferon alfa - 2a 48 weeks
  • nucleotide analogues e.g. tenofovir or entecavir . needed long term but better tolerated
287
Q

what % of Hep C infections become chronic?

A

75%

288
Q

how do we test for chronic HCV?

A

test for HBV antibodies, if +ve…
do HCV PCR - looking for RNA to confirm active disease
then use elastography to test liver for cirrhosis

289
Q

how is chronic HCV treate?

A 
antivirals: 
PEG inteferon
nucleotide analogue - ribavirin 
protease inhibitor 
ledipasvir, soforbuvir - non structural viral protein inhibitors
290
Q

what are features of Hep E infection?

A

virtually identical to Hep A infection
may cause severe disease in pregnancy - high mortality. especially if infected in 2nd trimester
associated with pigs
v.rare in england

291
Q

what are features of hepatitis delta?

A

it has incomplete RNA and so needs to co-infect with Hep B
can worsen the prognosis of Heb B
vaccination for Hep B also vaccinates against Hep Delta
treat with interferon alpha

292
Q

what are symptoms of hepatitis?

A

may be asymptomatic
nausea, vomiting, malaise, raised temp, muscle and joint pain, dark urine, pale stools, jaundice, pruritis, abdo paina, exhaustion

293
Q

what are the LFT levels in hepatitis?

A 
raised bilirubin 
raised ALT>AST
raised urea
mildly prolonged PTT
raised creatinine in fulminant liver failure
294
Q

what is cholelithiasis?

A

presence of gall stones in gall bladder

presents as biliary colic - stones temporarily blocking the bile duct

295
Q

what are gallstones made from?

A

90% are made of cholesterol

5-10% - pigmented

296
Q

how does biliary colic present?

A

RUQ pain, radiating to shoulder
occurs for 30mins-hours, post prinadially
increases in intensity

297
Q

what imaging should be done for biliary colic?

A

abdo ultrasound - pick up any gallstones and guide further imaging
if unremarkable, abdo CT to find alternative diagnosis
if stones in bile duct are suspected - decide between MRCP and intraoperative imaging

298
Q

what is choleodolithiasis ?

A

gallstones in the common bile duct

299
Q

what are the symptoms of choleodolithiasis?

A

RUQ pain, biliary colic, jaundice, pale stools

300
Q

how is choleodolithiasis treated?`

A

treatment of choice is ERCP with sphinctnotomy and stone extraction to avoid complications e.g. acute (ascending) cholangitis or pancreatitis

301
Q

what is cholangitis?

A

infection of the biliary tree - most commonly caused by obstruction from gallstones

302
Q

what is charcot’s triad?

A

for diagnosing acute cholangitis

  1. RUQ pain
  2. fever
  3. jaundice
303
Q

what imaging is down for suspected cholangitis?

A

abdo ultrasound - to detect a dilated common bile duct
if negative image then do a CT abdo with IV contrast
patients with history of biliary disease = consider early ERCP

304
Q

what is the management for ascending cholangitis?

A
  1. broad spec antibiotics e.g. Pip/Taz
  2. rehydration
  3. electrolyte and coagulation therapy may be needed
  4. analgesia
  5. decompression with ERCP ( with or without sphinctenotomy) and stent insertion for drainage
305
Q

what is cholecystitis?

A

acute gallbladder infection

usually due to an impacted gallstone in the cystic neck

306
Q

how does cholecystitis present?

A

nausea, RUQ tenderness/palpable mass, positive murphey sign,
fever, pain lasting 3-6 hours, unremitting

307
Q

how is cholecystitis treated?

A

Nil by mouth, antibiotics, analgesia, rehydration
grade severity
cholecystectomy - within 72 hours of symptom onset
2nd line = PCT percutaneous cholecystectomy tube inserted

308
Q

how does pancreatitis present?

A

sudden intesne pain in epigastric region
radiates to back
nasuea and vomiting
fever and tachycardia
pain worse on moving, alleviated in fetal position

309
Q

what are important blood test results in pacreatitis?

A

raised amylase/lipase (> 3 x the upper limit)

310
Q

what investigations should be performed for suspected pancreatitis?

A

ultrasound - if suspected biliary disease cause
CT - best for staging pancreatitis and looking for complications
MRCP used more for serial examinations

311
Q

how is acute pancreatitis managed?

A

NPO, rehydration, analgesia + anti-emetics
monitor ABGs, blood glucose, oxygen levels closely
identify electrolyte imbalances and correct
treat based on aetiology.
- if gallstones = cholecystectomy or ERCP with sphincterotomy
- if alcohol = lorazepam and vitamin replacement

312
Q

how does chronic pancreatitis present?

A

dull aching epigastric pain, radiating to back. worse ~30 mins after a meal.
associated with heavy alcohol consumption
jaundice (10%)
diabetes and glucose intolerance
steatorrhea
malnutrition

313
Q

initial tests for suspected chronic pancreatitis?

A

amylase, glucose
abdo XR - look for calcifications
if negative - pancreas protocol CT

314
Q

how is chronic pancreatitis managed?

A
  1. analgesia
  2. pancreatic enzymes - pancreatin, Creon
  3. smoking and alcohol cessation
  4. omeprazole (PPI) - reduce enzyme deactivation in the lumen
  5. dietary modification/enteral feeding

if still unbearable - surgical intervention. resection - pancreaticoduodenectomy. (whipple procedure)

315
Q

what is a whipple’s procedure?

A

pancreaticoduodenetomy

removal of the pancreatic head, gallbladder and bile duct

316
Q

how do we grade hepatic encephalopathy?

A

1) altered mood/behaviour. poor sleep, poor arithmetic, dyspraxia
2) drowsiness, confusion, slurred speech, liver flap, personality change
3) stupor, incoherent, restless, liver flap
4) coma

317
Q

how does liver failure lead to cerebral oedema?

A

ammonia waste builds up. in the brain this waste is cleared by astrocytes in a process involving glutamate. glutamine builds up and causes an osmotic imbalance - and shift of fluid.

318
Q

how is cirrhosis defined?

A

irreversible liver damage

loss of normal hepatic architecture with bridging fibrosis and nodular regeneration

319
Q

what does loss of function of the liver lead to?

A

jaundice
decreased hormone metabolism (raised oestrogen)
decreased drug metabolism
decreased immunity, so increased risk of sepsis
coagulopathy

320
Q

what does portal hypertension cause?

A 
varices 
 ascites 
caput medusa
splenomegaly 
renal failure 
piles 
 encephalopathy

3rd Year Medicine UoM (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions